WIREDGOV

CQC’s annual report on the safer management of controlled drugs in England highlights key findings from our work in 2023 under the Controlled Drugs (Supervision of Management and Use) Regulations 2013.

Risks associated with controlled drugs are still present within health and care systems, which are constantly changing.

Key issues:

• Prescribing of controlled drugs from outside England continues to be an issue. This regulatory gap has resulted in people accessing a range of inappropriately prescribed medicines, including large quantities of Schedule 4 and 5 controlled drugs, which have resulted in both harm and death.
• There is a significant increase in the number of cannabis-based products for medicinal use (CBPMs) prescribed privately in the independent sector. The most current available prescribing data for independent services has shown an increase of 118% between 30 June 2022 and 30 June 2023. The number of unlicensed CBPMs prescribed each year continues to increase by at least 100% annually.

The report provides data and commentary on national prescribing trends of the most prescribed controlled drugs in England in 2023.

Total controlled drug items prescribed by NHS primary care services:

73,830,666 items in 2023

73,880,442 items in 2022

(a small decrease of less than 0.5%)

Key trends in 2023:

• Continued increases in prescribing volumes of medicines that are licensed to treat attention deficit hyperactivity disorder (ADHD), such as dexamfetamine, lisdexamfetamine and methylphenidate. This trend is also echoed in NHS hospital prescribing for dispensing in the community, as well as in the private prescribing trends.
• Similar to last year, an increase in testosterone prescribing, which could be linked to increased awareness of its use for women experiencing menopause.
• A reduction in prescribing of pholcodine (after changes to clinical guidance and availability), pethidine, co-proxamol, fentanyl and diamorphine. We have also seen reduced fentanyl patch prescribing in certain age groups.
• An increase in non-medical prescribing. Similar to last year, pharmacists account for over half of non-medical prescribing.
• A continued trend in reduced prescribing by NHS dentists, possibly linked to dental access issues.

CQC also makes recommendations to raise awareness and address some of the specific issues identified during the last year:

• For health and care services: - share information about concerns in relation to controlled drugs with the right organisations as soon as possible, including with NHS England controlled drugs local intelligence networks.
• For national bodies and government - address online prescribing of controlled drugs in Schedules 4 and 5 by services and prescribers outside of the United Kingdom and review the impact of the 2018 legislation change to allow prescribing of cannabis-based products for medicinal use (CBPMs).
• For police services – check that controlled drugs liaison officers are adequately resourced to provide support and advice for services that use controlled drugs.